The most promising advances in cancer treatment today center around personalized or precision medicine, but what exactly does that mean? We asked Dr. Fadlo Khuri, deputy director of the Winship Cancer Institute of Emory University, to explain the terms and help us understand who is benefitting from these types of treatment.
Q: What is personalized or precision medicine in cancer treatment?
Khuri: The best individualized care plan for every patient is one that delivers the most precise, informed and effective treatment possible. One of the new tools we use today in order to add to the patient’s medical history, social history, and pathologic diagnosis, is modern molecular testing.
Q: What is molecular testing?
Khuri: Molecular testing in cancer is performed on tissue taken during a tumor biopsy. Several tests can be done to reveal the genetic makeup of the mutation present in the cells of a particular cancer, such as non-small cell lung cancer. This genetic mapping, or DNA sequencing, is called genomics.
Q: People are familiar with genetic testing for the BRCA gene mutations that cause ovarian and breast cancers. But how are genomics or genetic targeting used in cancer treatment?
Khuri: Genomics uses modern DNA sequencing methods, recombinant DNA and informatics to study the complete genetic makeup of individual cells, patients, populations and their diseases. We learn how certain gene mutations, such as EGFR or ALK mutations in lung cancer, determine a tumor’s behavior and survival. We use these driver mutations to design treatments that specifically target the protein product of the mutated (or altered) genes. This leads to more targeted treatments based on an individual patient’s cancer.
Q: What is immunotherapy and how is it being used at Winship?
Khuri: Immunotherapy is a type of treatment that stimulates a patient’s own immune system to either work harder overall, or to attack cancer cells specifically. We are exploring immunotherapy at Winship through research and clinical trials. We have a series of clinical trials designed to activate or drive the immune system to recognize the individual’s cancer as foreign to their body, such as vaccines or immune checkpoint inhibitors, to attack the tumor.
Q: Which type of patients benefit from immunotherapy?
Khuri: Patients with leukemia, lymphomas, myeloma, lung cancer, kidney cancer and especially melanoma seem to benefit from immunotherapy. Other diseases are also being studied. Immunotherapies are demonstrating durable (long lasting) responses in a number of the above tumor types, and this has added a powerful new option to the toolbox of targeted therapies of cancer.
Q: What are the advantages and challenges?
Khuri: The advantages include the durability of the responses seen, but the people with cancer who benefit are in the minority so far. Efforts at developing efficient and precise ways to deliver immunotherapy are ongoing.
Q: What is the latest research at Winship that is related to precision medicine?
Khuri: Winship has clinical trials in myeloma, lung cancer, leukemia, lymphoma, breast cancer, colon cancer, thyroid cancer and melanoma which target specific driver mutations and are excellent examples of precision medicine.
Q: How have these approaches changed the way doctors now treat cancer patients?
Khuri: Many centers, like Winship, do reflex testing, which automatically sends a patient’s sample for a molecular screening panel that looks for tumor mutations. Certain gene mutations are known to drive cancer growth, cause drug resistance or susceptibility, or are currently under investigation as therapeutic targets in clinical trials, so the results of those tests can determine the type of treatment a patient receives.
About Dr. Khuri
Fadlo R. Khuri, MD, deputy director of the Winship Cancer Institute of Emory University and Professor and Chairman of the Department of Hematology & Medical Oncology, Emory University School of Medicine, is a leading researcher and physician in the treatment of lung and head and neck cancers. He is Editor-in-Chief of the American Cancer Society’s peer-reviewed journal, Cancer.
Dr. Khuri’s contributions have been recognized by a number of national awards, including the prestigious 2013 Richard and Hinda Rosenthal Memorial Award, given to an outstanding cancer researcher by the American Association for Cancer Research.
An accomplished molecular oncologist and translational thought leader, Dr. Khuri has conducted seminal research on oncolytic viral therapy, developed molecular-targeted therapeutic approaches for lung and head and neck tumors combining signal transduction inhibitors with chemotherapy, and has led major chemoprevention efforts in lung and head and neck cancers. Dr. Khuri’s clinical interests include thoracic and head and neck oncology. His research interests include development of molecular, prognostic, therapeutic, and chemopreventive approaches to improve the standard of care for patients with tobacco related cancers. His laboratory is investigating the mechanism of action of signal transduction inhibitors in lung and aerodigestive track cancers.